CITY OF OWENSBORO/DAVIESS COUNTY FISCAL COURT                                                              FORM 1099 ST
                     SUMMARY AND TRANSMITTAL OF 
                             NON-EMPLOYEE EARNINGS                                               YEAR
 100% City of Owensboro                                                                         ACCOUNT NUMBER
 100% Daviess County

NAME:
ADDRESS:

MAIL TO:
    OCCUPATIONAL TAX ADMINISTRATOR
    PO BOX 10008                                                                                 Phone:  (270) 687-5600
    OWENSBORO KY  42302-9008                                                                     Fax:  (270) 687-8526

                                                      INSTRUCTIONS:
Licensees making payments of $600 or more to recipients other than employees, (i.e., non-employee compensation payments) for services performed or 
rents paid on property located within the City of Owensboro and/or Daviess County are responsible to maintain records of those payments.  The licensee
making payment will be responsible for completing Form 1099-ST and submitting it to the Occupational Tax Administrator  by February 28  of the year
 following the close of the calendar year in which the non-employee compensation was paid. Businesses that make subject payments, where all monies
reported over $600 were paid to recipients for work performed 100% within the City Limits of Owensboro or 100% within Daviess County, outside the 
City of Owensboro, may comply with the reporting requirement by checking the appropriate “100%” box on Form 1099-ST (see above), and submitting
 copies of Federal Form 1099 MISC. (Completion of Columns 1 through 5 of Form 1099-ST  not  required if the licensee is eligible to submit 1099MISC, 
unless payment is made to an entity not requiring the completion of a Federal Form 1099 MISC, such as payments to corporations.)

                                  RETURN THIS PAGE WITH NON-EMPLOYEE INFORMATION

        COLUMN 1                  COLUMN 2                         COLUMN 3                      COLUMN 4                       COLUMN 5
Name and Address of each Non-Employee Social Security No. or Federal  Total Compensation Paid to Non-Employee Compensation      Non-Employee Compensation 
     receiving compensation       ID No for each Non- each Non-Employee                          from Column 3, for Work        from Column 3, for Work 
                                  Employee                                                       Performed within the City of   Performed within Daviess 
                                                                                                 Owensboro                      County (Outside the City of 
                                                                                                                                Owensboro)

Preparer's Signature                                                                             Preparer's Phone

COLUMN 1               COLUMN 2            COLUMN 3                                              COLUMN 4                     COLUMN 5
Name and Address of each Non-Employee Social Security No. or Federal  Total Compensation Paid to Non-Employee Compensation    Non-Employee Compensation 
receiving compensation ID No for each Non- each Non-Employee                                     from Column 3, for Work      from Column 3, for Work 
                       Employee                                                                  Performed within the City of Performed within Daviess 
                                                                                                 Owensboro                    County (Outside the City of 
                                                                                                                              Owensboro)